Healthcare Provider Details

I. General information

NPI: 1730198599
Provider Name (Legal Business Name): MEDICAL ARTS PROFESSIONAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13215 SPRING HILL DR
SPRING HILL FL
34609-5054
US

IV. Provider business mailing address

13215 SPRING HILL DR
SPRING HILL FL
34609-5054
US

V. Phone/Fax

Practice location:
  • Phone: 352-683-0232
  • Fax: 352-683-0247
Mailing address:
  • Phone: 352-683-0232
  • Fax: 352-683-0247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH0002734
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME55252
License Number StateFL

VIII. Authorized Official

Name: THAIR R DIEFFENBACH
Title or Position: PH.D.
Credential: L.M.H.C.
Phone: 352-683-0232